Arrhythmias and conduction disturbances
Usefulness of electroanatomical mapping to differentiate between right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia

https://doi.org/10.1016/j.amjcard.2004.12.030Get rights and content

Differentiation between the different right ventricular rhythm disorders and specifically between arrhythmogenic right ventricular dysplasia (ARVD) and right ventricular outflow tract (RVOT) tachycardias has important clinical implications but remains a clinical challenge. We tested the hypothesis that the spatial association of local electrographic parameters may be used to discriminate between these 2 entities. Electroanatomic mapping of the right ventricle was performed in 3 groups: patients who had typical RVOT tachycardia, a control group of patients who had no ventricular arrhythmias, and patients who had a diagnosis of ARVD based on clinical, electrocardiographic, and structural findings. Electroanatomic mapping in the RVOT tachycardia group showed normal electrographic parameters throughout the right ventricle (unipolar electrographic amplitude 9.9 ± 0.9 mV, duration 55 ± 1 ms, amplitude/duration 0.193 ± 0.022) that were no different from those in the control group. In contrast, dysplastic regions in the ARVD group were characterized by significantly lower amplitude (unipolar 3.6 ± 0.4 mV), prolonged electrographic duration (unipolar 73 ± 4 ms), and a decreased amplitude/duration ratio (unipolar 0.054 ± 0.008) compared with the unaffected zones in the same hearts and with all regions in the RVOT and control groups. Thus, endocardial electrographic parameters do not differ between patients who have RVOT and control patients. RVOT tachycardia can be differentiated from ARVD by the absence of abnormal right ventricular electrographic findings. This ability may have important clinical implications and supports the concept of different underlying mechanisms for these 2 entities.

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Patient groups

All patients gave written informed consent to the electrophysiologic and ablation studies. The RVOT tachycardia group consisted of 12 patients (4 men and 8 women; mean age 38 ± 8 years old) who had recurrent episodes of symptomatic tachycardia. Only patients who had typical RVOT tachycardia were included in the study. Physical examination, chest x-rays, and 12-lead electrocardiograms were normal in all patients. All patients underwent transthoracic echocardiography, including 2-dimensional,

Results

Detailed electroanatomic maps were generated in all patients in the control (Figure 1), RVOT (Figure 2), and ARVD (Figure 3) groups.

Discussion

In this study we compared electroanatomic findings in patients who had RVOT tachycardia with those in patients who had established ARVD and control patients who had no evidence of ventricular arrhythmia. The major findings of this study are that the local endocardial electrograms in the RVOT tachycardia group were characterized by preserved voltage and short durations throughout the right ventricle and that these parameters did not differ significantly from those measured in controls. Our

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